quinupristin-dalfopristin and Pneumonia

Quinupristin/dalfopristin is a new water-soluble streptogramin antimicrobial agent comprising quinupristin and dalfopristin in a ratio of 30:70. The in-vitro spectrum of activity includes most multi-resistant Gram-positive aerobes, important Gram-negative aerobes, Gram-positive anaerobes and intracellular bacteria that are causal agents of respiratory, blood and cutaneous infections. Of particular note, quinupristin/dalfopristin is active against multidrug-resistant isolates of Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecium, and against penicillin-resistant and/or erythromycin-resistant Streptococcus pneumoniae. The combination is also active against staphylococci showing both constitutive and inducible erythromycin resistance. Bactericidal activity and a prolonged post-antibiotic effect have also been noted for quinupristin/dalfopristin against Gram-positive cocci. Gram-negative bacteria susceptible to quinupristin/dalfopristin include Moraxella catarrhalis, Legionella spp. and Mycoplasma spp. Overall, the spectrum of antibacterial activity indicates a potential role for this combination in the treatment of difficult-to-treat Gram-positive infections, including those caused by multidrug-resistant organisms. Since this activity extends to Gram-negative respiratory bacteria, quinupristin/dalfopristin may also find a role in the treatment of atypical, as well as typical, pneumonia.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Enterococcus; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Pneumonia; Staphylococcus; Streptococcus; Virginiamycin

NOSOCOMIAL PNEUMONIA DUE TO GRAM-POSITIVE COCCI: In a randomized multicentric trial comparing Synercid with vancomycin, the cure rate (56.3% vs 58.3%) were equivalent in the 2 treatment arms. Treatment failures were also similar: 44% vs 42%. Mortality (25% vs 22%) was likewise comparable, as was tolerance. SKIN AND SOFT TISSUE INFECTIONS: For erysipela, infections requiring surgical dissection, post-trauma infections, postoperative wound infections, or diabetes-related infections, the rate of success obtained in 2 open randomized comparative multicentric trials was equivalent in the 2 treatment arms: 68.2% for Syncercid, 70.7% for the compared treatments. EMERGENCY PRESCRIPTION: For E. faecium, the success rate was 74% based on clinical assessment and 70.5% based on bacteriological assessment. For meti-S S. aureus infections, the clinical success rate was 74% for all patients and 80% for bacteriologically evaluable patients; the bacteriological success rate was 74% and 71% respectively. In case of infection due to C-MLSB meti-R S. aureus, the percentage of clinical success was 89% for bacteriologically evaluable patients.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Approval; Drug Resistance, Multiple; Drug Therapy, Combination; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Multicenter Studies as Topic; Pneumonia; Randomized Controlled Trials as Topic; Soft Tissue Infections; Virginiamycin

Topics: Acetamides; Anti-Infective Agents; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Linezolid; Oxazolidinones; Pneumonia; Skin Diseases, Infectious; Vancomycin Resistance; Virginiamycin